Viscoelastic testing in cardiac surgery

Abstract

Bleeding complications are common in cardiac surgery and lead to an increase in morbidity and mortality. This is multifactorial in aetiology including the effects of cardiopulmonary bypass, the drugs given to manipulate the coagulation system and the vascular nature of the surgery itself. Viscoelastic tests provide a point of care, rapid assessment of coagulation which offer the advantage of faster turnaround times and a nuanced view of the elements of the coagulation system allowing targeted therapy to be delivered quickly. Both thomboelastography (TEG) and thromboelastometry (ROTEM) have been recommended for use in cardiac surgery, both have shown a reduction in transfusion and bleeding when used as part of a testing algorithm. They are particularly useful in assessing residual heparinisation and fibrinogen levels. Additionally, TEG allows the evaluation of the effects of anti-platelet agents on platelet function. This review discusses the mechanisms by which bleeding occurs in cardiac surgery and explores three uses of viscoelastic testing in cardiac surgery: to predict bleeding, to assess platelet function and peri-operative testing to reduce transfusion

TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit

“…TEG ® and ROTEM ® have been extensively studied and applied in adult patients, especially in major bleeding related to severe trauma and surgical fields, such as liver transplantation as well as cardiac and obstetric procedures. Their use has been largely considered in the management of trauma-induced coagulopathy because of their great precision to identify the lacking element involved in the hemostasis reaction [ 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Real-time monitoring of intravenous thrombolysis in acute ischemic stroke using rotational thromboelastometry: a feasibility pilot study

“…It has the advantage of being able to serve as a bedside monitoring test in terms of a point-of-care assessment [7]. Viscoelastic assays therefore are already in successful clinical use for the evaluation of blood transfusion requirements during cardiac surgery, trauma-induced coagulopathy and coagulation monitoring in liver transplantation [8][9][10][11]. The most frequently used VEM test systems are thromboelastography (TEG) and rotational thromboelastometry (ROTEM) [12].…”

Impact of general anesthesia on rotational thromboelastometry (ROTEM) parameters and standard plasmatic coagulation tests in healthy Beagle dogs

“…Thromboelastometry parameters in people after sevoflurane or propofol anesthesia were not different to preanesthetic measurements ( Koo et al., 2014 ) . However, the effect of intra-anesthetic assessment of coagulation parameters has never been studied in people despite the widespread use of viscoelastic tests during anesthesia for trauma-related, cardiac and transplantation surgery ( Agarwal & Abdelmotieleb, 2020 ; Sayce, Neal & Leeper, 2020 ). To the authors’ knowledge in dogs neither intra- nor postanesthetic measurements were compared to preanesthetic measurements.…”